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Biomedical subjects

R S Procianoy

Publications and source records attributed to R S Procianoy.

At least 37 records · Page 2Linked to original sources
PubMed1983

Umbilical cord cortisol and prolactin levels in preterm infants. Relation to labor and delivery.

The influence of labor and route of delivery upon the umbilical cord serum levels of cortisol and prolactin in ninety-nine preterm infants not exposed prenatally to corticosteroids was studied. Vaginally born infants (group A) presented a higher mean cord cortisol concentration than those delivered by cesarean section (group B); mean prolactin values, however, were not different between both groups. Although there was no difference in cortisol and prolactin levels between infants delivered by cesarean section after spontaneous onset of labor (group B-I) and those without labor (group B-II), the mean cortisol concentration was significantly higher in group A than in group B-I. The mean prolactin levels did not differ among all the studied groups. It is concluded that there is no association between presence of labor or route of delivery and cord serum levels of prolactin, there is no association between spontaneous preterm labor and cord cortisol values and there is an association between vaginal delivery and high cord cortisol levels in preterm infants. It is suggested that the increase in serum cortisol levels does not precede the initiation of preterm parturition but it is secondary to the stress caused by vaginal delivery.

Cesarean Section↗
PubMed1982

The hyaline membrane disease-intraventricular hemorrhage relationship in the very low birth weight infant: perinatal aspects.

A large retrospective clinical study is reported confirming pathologic studies upon the effect of hyaline membrane disease on the occurrence of intraventricular hemorrhage in very low birth weight infants. Two hundred and twenty infants with birth weight less than or equal to 1 500 g and gestational age less than or equal 32 weeks were studied. Infants with hyaline membrane disease (112) had 56% incidence of intraventricular hemorrhage whereas of those without hyaline membrane disease (108) only 31% developed intraventricular hemorrhage (p less than 0.001). When controlled for gestational age, the more immature infants (less than or equal to 1 000 g) exhibited no difference in the occurrence of intraventricular hemorrhage whether hyaline membrane disease coexisted or not. In the 1 001-1 500 g group, the occurrence of hyaline membrane disease with intraventricular hemorrhage was significant (p less than 0.001). The association of lower Apgar scores and the influence of intermittent positive pressure ventilation in infants with intraventricular hemorrhage is discussed. Extreme immaturity negates all perinatal clinical expertise in determining neonatal outcome. Therefore, carrying pregnancies beyond 28 weeks gestation is mandatory. Beyond 28 weeks, pulmonary maturity and the influence of therapeutic modalities and maternal transport become increasingly important.

Birth Weight↗
PubMed1981

An association between retinopathy of prematurity and intraventricular hemorrhage in very low birth weight infants.

An association between cicatricial retinopathy of prematurity and intraventricular hemorrhage in very low birth weight infants was investigated retrospectively. Newborns were studied who weighed less than or equal to 1500 g at birth, who were less than or equal to 32 weeks gestational age and appropriate by weight, and admitted in the first 24 hours of life to our Neonatal Intensive Care Unit. Diagnosis of retinopathy of prematurity was made by retinal examination at approximately 4 weeks of age. Diagnosis of intraventricular hemorrhage was made by computerized tomography and clinical findings. A total of 138 infants were studied and divided into two groups: (A) birth weight less than or equal to 1000 g (31); (B) birth weight 1001--1500 g (107). There was a statistically significant association between cicatricial retinopathy of prematurity and intraventricular hemorrhage in both groups. There were no statistical differences between birth weight, gestational age, duration of oxygen therapy, highest oxygen concentration received, Apgar scores, incidence of hyaline membrane disease and patent ductus arteriosus between cicatricial retinopathy of prematurity and no retinopathy of prematurity patients in either group. This association may be an important consideration in the pathogenesis of both vascular diseases.

Cerebral Hemorrhage↗
PubMed1981

Blood pesticide concentration in mothers and their newborn infants. Relation to prematurity.

An association between high DDT cord blood levels and prematurity was investigated. Pregnant women with good health and nutritional condition, negative history of past occupational exposure to DDT and absence of recent exposure to DDT were investigated as well as their appropriate for gestational age neonates. A total of 54 maternal-infant pairs were studied and divided in two groups: A-term deliveries (30 pairs), B-preterm deliveries (24 pairs). There was no difference in DDT blood levels between pregnant women of both groups. There was, however, a significant difference in DDT cord blood levels between term and preterm infants, as well as between maternal and neonatal blood levels in both groups. DDT cord blood levels correlated negatively with infants' birth weights. We suggest that there is an association between prematurity and high DDT cord blood levels in a non-occupationally exposed population and the amount of fetal adipose tissue is an important factor determining the cord blood level of this pesticide. We cannot rule out a cause-effect association between high DDT cord blood level and prematurity.

Adipose Tissue↗
PubMed1980

Use of indomethacin and its relationship to retinopathy of prematurity in very low birthweight infants.

The relationship between the use of indomethacin, a prostaglandin inhibitor, for closure of patent ductus arteriosus (PDA) and the occurrence of retinopathy of prematurity was investigated retrospectively. 63 preterm infants less than or equal to 1500 g who were less than or equal to 32 weeks' gestational age, appropriate weight for gestational age, with a diagnosis of PDA, and admitted during the first 24 hours of life were studied. Diagnosis of retinopathy was made by retinal examination when each infant was about 4 weeks. Diagnosis of PDA was made by clinical, radiological, and echocardiographic findings. 15 patients were treated with indomethacin because of severe congestive heart failure. There were no differences between gestational ages, birthweights, duration of oxygen therapy, or incidence of retinopathy in treated and untreated patients. We suggest that the use of indomethacin for PDA closure does not increase the incidence of retinopathy in very low birthweight infants.

Ductus Arteriosus, Patent↗
PubMed1980

Hyaline membrane disease and intraventricular haemorrhage in small for gestational age infants.

19 small for gestational age (SGA) infants with gestational ages less than or equal to 32 weeks were matched with 19 appropriate for gestational age (AGA) preterm neonates with similar risk factors for intraventricular haemorrhage and hyaline membrane disease. Gestational age, 1- and 5-minute Apgar scores, type of delivery, survival rate, use of corticosteroids before delivery, sex, twinning, presence of premature rupture of membranes, and birth date were comparable in the two groups. Gestational age of both groups was 30 (+/- 1.8) weeks, and birthweights were 919 (+/- 202) g (SGA group) and 1268 (+/- 212) g (AGA group). The incidences of hyaline membrane disease and intraventricular haemorrhage were different: 74 and 42% respectively for AGA neonates, 5 and 11% respectively for SGA infants. We suggest that a stressful environment in utero may enhance maturation and prevent hyaline membrane disease and intraventricular haemorrhage.

Cerebral Hemorrhage↗
PubMed1980

Hypochloremic metabolic alkalosis following tolazoline-induced gastric hypersecretion.

Gastric hypersecretion following administration of tolazoline resulted in severe hypochloremic alkalosis in an infant with persistent fetal circulation. An initial bolus injection of 2 mg/kg was followed by an infusion of 5 mg/kg/hr for 24 hours. The infusion was then maintained at 2 mg/kg/hr for the next four days. Volume of gastric secretions exceeded 25 ml/kg/24 hr. Weaning from tolazoline and replacement of chloride and potassium corrected the metabolic alkalosis.

Alkalosis↗
PubMedDate not supplied

[The effect of recombinant human erythropoietin on the treatment of anemia of prematurity]

OBJECTIVE: To assess the efficacy of erythropoietin in the prevention and treatment of anemia of prematurity, correlating the use of this drug with weight gain, length, and head circumference and comparing two administration schemes of he same weekly dose: daily use and twice a week. METHODS: The study comprised 42 premature newborns with gestational age up to 33 weeks, birthweight up to 1550 g, and postnatal age between 10 and 35 days. The newborns were randomized into three groups: patients in group 1 received seven daily doses of 100 U/kg erythropoietin per week; patients in group 2 received two 350 U/kg erythropoietin doses per week; and patients in group 3 did not receive the drug. Hematologic measurements, blood transfusion requirements, and growth rates were followed during therapy. RESULTS: Cases and controls did not differ with respect to weight, length, head circumference, and total time of hospital stay. At the end of the study, no significant difference was observed in the platelet count measurement means, white blood cell count, and ferritin levels in the three groups. However, the final hematocrit and hemoglobin values of patients who did not receive erythropoietin were significantly lower than those of patients who received the drug. The absolute reticulocyte count mean was significantly higher in patients who received erythropoietin after two weeks of treatment when compared with those patients who did not receive the drug. Patients in group 1 e 2 received fewer excessive transfusions (2 or more) than patients in group 3. The administration of 700 U/kg/week erythropoietin significantly reduced the number of excessive blood transfusions. There is no significant difference in blood transfusion volume between patients who received erythropoietin on a daily basis and those who received the drug twice weekly. CONCLUSIONS: the use of erythropoietin did not influence weight gain and growth. The administration of 700 U/kg/week erythropoietin in premature infants with gestational age up to 33 weeks and birthweight up to 1550 g stimulates erythropoiesis and significantly reduces excessive blood transfusion requirements. Erythropoietin showed to be a safe and well tolerated medication, with no short-term side effects in the study population.

Journal Article↗
PubMedDate not supplied

[Effect of perinatal asphyxia on thyroid hormones]

OBJECTIVE: To verify the effect of perinatal asphyxia on thyroid hormone levels in term newborn infants. METHODS: We carried out a case-control study with 17 term and asphyxiated (A) and 17 term and control (N) newborn infants at the Hospital de Clínicas de Porto Alegre. Patients were paired according to color of skin, sex, type of delivery, gestational age, and weight at birth. We collected umbilical cord plasma T4, T3, free T4, reverse T3, and TSH after 18 to 24 hours of life and from asphyxiated and control newborn infants. RESULTS: There were no differences in thyroid hormones of cord blood, with the exception of reverse T3, which was higher in A than in controls [median (25th-75th percentile): A= 2(1.4-2); N= 1.41 (1.13-1.92); P=0.037)]. Thyroid hormone levels were lower in A than in controls on samples collected within 18-24 hours after birth, except for reverse T3, which was similar in both groups [average -/+ SD: T4 A= 9.79 -/+ 2.59; N=14.68 -/+ 3.05; P<0.001; median T3 A= 40.83 (37.4-80.4); N= 164 (56.96-222.5); P=0.003; average -/+ SD: free T4 A=1.85 -/+ 0.92; N= 2.8 -/+ 0.74; P=0.004; median: reverse T3 A=1.54 (1.16-1.91); N=1.31(0.87-2); P=0.507; TSH A=9.1 (6.34-12.95); N=14.5(12.9-17.85); P=0.008]. CONCLUSIONS: Our data suggest that lower T4, free T4, and T3 levels are secondary to lower TSH levels in asphyxiated newborns; also, peripheral metabolism of T4 in asphyxiated infants can be altered due to low T3 and normal reverse T3 levels.

Journal Article↗
PubMedDate not supplied

[Plasmatic levels of interleukin-1beta and interleukin-6 in newborn infants with fever]

OBJECTIVE: To study plasma levels of IL-1beta and IL-6 in order to distinguish the presence of bacterial infection in newborn infants with fever. METHODS: A cohort of 117 newborn infants with postnatal age equal to or less than 5 days, with no previous use of antibiotic therapy, and with clinical suspicion of bacterial infection was studied from July 1995 through August 1996. Those with definite criteria for sepsis were considered infected. Fever was defined as axillar temperature > 37.5 degrees C in three independent measurements. The patients were classified in four different groups: Group 1: infected with fever; Group 2: infected without fever; Group 3: not infected with fever; Group 4: not infected without fever. Complete blood count, platelet count, blood or other fluid cultures, and plasmatic levels of IL-1beta and IL-6 were collected before the beginning of antibiotic therapy. RESULTS: Of the 117 newborn infants studied were 66 infected and 51 not infected. Fever was present in 45 (38.46%). The median values of IL-1beta and IL-6 were significantly higher in newborn infants with fever than in those with no fever. There were significant differences between groups 1 and 2, 1 and 4, and 2 and 3 for IL-1beta. There were no significant differences between groups 2 and 4, and 1 and 3 for IL-1beta. Eight (72%) newborn infants with no infection and no fever had environment heating, and 3 had dehydration. There were no differences in median IL-6 levels between groups 1 and 2, and 3 and 4. There were significant differences in the median IL-6 levels between groups 1 and 3, and 1 and 4. CONCLUSIONS: IL- 6 is a marker of early neonatal sepsis. IL-1beta is related to neonatal fever response independently of the presence of bacterial infection.

Journal Article↗
PubMedDate not supplied

[Do newborn infants feel pain when submitted to gastric suctioning?]

OBJECTIVES: Evaluate physiological and behavioral parameters to verify if newborns feel pain when submitted to gastric suctioning. METHODS: 50 healthy newborns over 33 weeks gestational age, weighing more than 1999g, were submitted to gastric suctioning, randomly selected, and divided into two groups: Friction/Lancing and Lancing/Friction. The newborns were assessed through the Neonatal Infant Pain Scale (NIPS) (0-7, pain>3) by two independent observers in three different moments: one minute before, during, and one minute after gastric suctioning, heel lancing and foot friction, with simultaneous monitoring of heart rate, respiratory frequency, and hemoglobin oxygen saturation. RESULTS: The respiratory frequency only decreased during gastric suctioning (P=0.004). The heart rate was lower during gastric suctioning (P<0.0001), during the heel lacing procedure in the Friction/Lancing group (P=0.01), and during friction in the Friction/Lancing group (P=0.022). The hemoglobin oxygen saturation suffered no alterations during the three procedures. The results obtained through NIPS revealed that both groups felt pain during gastric suctioning and heel lancing, and did not feel pain during friction (P<0.0001). CONCLUSION: During the gastric suctioning procedure, newborns responded as if it were a painful stimulus. Physiological alterations were neither specific nor sensitive to pain assessment in newborn infants.

Journal Article↗
PubMedDate not supplied

[Clinical manifestations in term newborn infants with different degrees of acidemia in umbilical cord blood]

OBJECTIVE: To verify if Apgar score plus umbilical cord pH are adequate to predict which newborn infant will develop multiorgan system disfunction. METHODS: A study including all term newborn infants with Apgar scores in the first and fifth minutes of life < 7 and umbilical cord blood pH < 7.20 born in Hospital de Clínicas de Porto Alegre from March 1995 through March 1998 was performed. Venous umbilical cord blood was collected for blood gas analysis. Newborn infants were divided in two groups: Group A with pH < 7.0, and Group B with pH >/= 7.0 and < 7.20. Patients were evaluated for the presence of pulmonary hypertension, renal failure, inappropriate secretion of antidiuretic hormone, ischemic cardiopathy, early seizures, neurologic injury at hospital discharge and death. RESULTS: Twenty five newborn infants were included in the study.Twelve formed Group A, and 13, Group B. There were no differences between both groups in respect to mode of delivery, gender, color and birth weight. Group B had a lower gestational age than Group A. There were significant differences between both groups in mean cord blood pH, pCO(2) and BE (p<0.05). There was a positive association between umbilical cord blood pH and Apgar score. Higher occurrence of neurologic injury at hospital discharge in Group A was the only statistically significant clinical manifestation (p<0.05). CONCLUSION: Apgar score and umbilical cord pH are not adequate criteria to predict multiorgan system dysfunction.

Journal Article↗
PubMedDate not supplied

[Predictive value of SNAP and SNAP-PE for neonatal mortality]

OBJECTIVE: To evaluate the Score for Neonatal Acute Physiology and the Score for Neonatal Acute Physiology Perinatal Extension as neonatal mortality predictors in our neonatal intensive care unit, and to compare their results. METHODS: All newborn infants admitted to our neonatal intensive care unit from March 1997 through December 1998 were prospectively evaluated just at completion of 24 hours of life for SNAP and SNAP-PE. Exclusion criteria were: death or discharge from the neonatal intensive care unit in the first 24 hours of life, congenital malformations incompatible with life, and outborn infants. RESULTS: 553 newborn infants were included in the study and 54 died. The median SNAP and SNAP-PE values were higher in those who died. Infants were allocated to five different raising ranges of SNAP and SNAP-PE severity. SNAP: up to 6, 7-11, 12-15, 16-24, higher than 24 (mortality: 3%, 11%, 29%, 48%,75%, respectively). SNAP-PE: up to 11, 12-23, 24-32, 33-50, higher than 50 (mortality: 3%, 10%, 53%, 78%, 83%, respectively). The optimal cut off points based on ROC curve were 12 for SNAP, and 24 for SNAP-PE. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for death were figured out. SNAP 12: sensitivity 79.6%, specificity 71.7%, PPV 23.4%, NPV 97%. SNAP-PE 24: sensitivity 79.6%, specificity 80%, PPV 30%, NPV 97.3%. The area under the curve (Az) were 81.4% for SNAP, and 85.1% for SNAP-PE, both statistically significant. There were no statistical differences between the two areas under the curve. CONCLUSIONS: SNAP and SNAP-PE are excellent predictors of neonatal survival. Therefore, we recommend their use in Neonatal Intensive Care Units.

Journal Article↗